HomeMy WebLinkAbout08-05-15 (2) �� � i� • �
- .� pennsy�vania 15 0 5 61814 8
DEFARTMENT OF REVENVE EX(03-14)
REV-1500 OFFICIAI USE ONLY
Bureau of Individual Taxes County Code Year File Number
Po sox zaoso� INHERITANCE TAX RETURN �
Hartisburg,PA 17128-0601 RESIDENT DECEDENT � 1� {'�� �
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
07222014 0715930
DecedenYs Last Name Suffix DecedenYs First Name MI
PECKOVER DOROTHY I
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE BOXES BELOW
Q 1. Original Return Q 2. Supplemental Return Q 3 Remainder Return(date of death
prior to 12-13-82)
Q 4. Agriculture Exemption(date of Q 5. Future interest Compromise(date of Q 6. Federal Estate Tax Retum Required
death on or after 7-1-2012) death after 12-12-82)
Q 7. Decedent Died Testate Q 8. Decedent Maintained a Living Trust � 9. Total Number of Safe Deposit Boxes
(Attach copy of will) (Attach copy of trust.)
Q 10. Litigation Proceeds Received Q 11. Non-Probate Transferee Return Q 12. Deferral/Election of Spousal Trusts
(Schedule F and G Assets Oniy)
Q 13. Business Assets Q 14. Spouse is Sole Beneficiary
(No trust involved)
CORRESPONDENT—THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
CELIA PE�KOVER ( 717) 357-4724
First Line ofAddress
100 CLINES CHURCH RD
Second Line ofAddress
City or Post Office State ZIP Code
ASPERS PA 17304
Correspondent's email address: C P E C K 0 V E R n�C 0 M C A S T . N E T ���
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REGI9-�ER�WILLS U$�F ONLPri �
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REGiSTER OF WILLS USE ONLY f'�1 '� '��.�� �
DATE FILED MMDDYYYY -^� � � � �"�
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DATE FILED ST/tNtP -"� ���
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PLEASE USE ORIGINAL FORM ONLY
Side 1
L ������������������������������������������������������������ J
1505618148 1505618148
1
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� 1505618155
REV-1500 EX DecedenYs Social Security Number
DecedenYsNar�e: DOROTHY I PECKOVER 1i50-
1. Real Estate(Schedule A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . 1. D . 0 0
2. Stocks and Bonds(Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. � . �0
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C). . . . . . . 3. � . ��
4. Mortgages and Notes Receivable(Schedule D). . . . . . . . . .. . . . . . . . . . . . . . . . . . 4. � . ��
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). . . . . . . . 5. 12 2 3 . 8 6
6. Jointly Owned Property(Schedule F) �Separate Billing Requested. . . . . . . . 6 9 7 3 O . �5
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) 0 Separate Billing Requested . . . . . . . . 7. 5 0 8 5 6 . 13
8. Total Gross Assets tota��ines 1 throu h 7 61810 . 0 4
( 9 ). . . . . . . . . . .. . . . . . . . . . . . . . . . . . . 8.
9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . . . . . . . . g. 11311 . 5�
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I). . . .. . . . .. . . . . . .10. 7 416 . 2�
11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . .11. 18 7 2 7 . 7 0
12. Net Value of Estate Line 8 minus Line 11 �z. 4 3 0 8 2 . 3 4
( ). . . . . . . . . . . . . .. . . . . . . . . . . . . . . . .
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J). . . . . . . . . . . . . . . . . . . . . . . . ..13. � . 0 0
14. Net Value Sub'ect to Tax Line 12 minus Line 13 . . . . . . . . . . . . . 14. 4 3 O 8 2 . 3 4
1 ( ). . . . . .. . .. . .
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a)(1.2)X.0 O 15 O . 0 0
16.Amount of Line 14 taxable
atlinea�ratex.o 45 43082 . 34 �s. 1938 . 71
17. Amount of Line 14 0 . 0 0
taxable at sibling rate X • 12 ���
18. Amount of Line 14 taxable
at collateral rate X • 15 18. 0 . 0 0
19. TAXDUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .. . . . . . . . . . ... . . . . . . 19. 7,938 . 71
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT �
Under penalties of perjury,I declare I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct and complete.Declaration of preparer other than the person responsible for filing the return is based on all information of which preparer has
an knowled e.
SIGN RE OF PERSO ESPONSIBLE FOR F NG RETURN DATE
` �'� , �`��� ��g 08/04/15
ADDRESS
100 CLINES CHURCH RD ASPER PA 17304
SiGNATUR OF PREPARER OTHER THAN PERSON RESPONSIBLE FOR FIL HE RETURN DATE
,� �.�ry��� (� ��. �8/0 4/15
ADDRESS
357 YORK ST GETTYSBURG PA 17325
���������������������������������������������������I�������� Side 2
L 1505618155 1505618155 J
iii. . � i� ■ �
REV-1500 EX Page 3 File Number 150-26-1188
Decedent's Complete Address:
DECEDENT'S NAME
DOROTHYIPECKOVER
STREET ADDRESS
100 CLINES CHURCH RD
CITY STATE ZIP
ASPER PA 17304
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 1938.71
2. Credits/Payments
A. Prior Payments
B. Discount
(See instructions.) Total Credits(A+B) (2) 0.00
3. Interest
(3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT.
Fill in box on Page 2,Line 20 to request a refund. (4) 0.00
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 1938.71
Make check payable to: REGISTER OF WILLS, AGENT.
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PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred............................................................................... ❑ ❑X
b. retain the right to designate who shall use the property transferred or its income................................. ❑ ❑X
c. retain a reversionary interest.................................................................................................................. ❑ ❑X
d. receive the promise for life of either payments,benefits or care?.......................................................... ❑ �
2. If death occurred after Dec. 12, 1982,did decedent transfer property within one year of death
without receiving adequate consideration?.................................................................................................. ❑ 0
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?................................ QX ❑
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation?............................................................................................................. � ❑
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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For dates of death on or after July 1, 1994,and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving
spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)].
For dates of death on or after Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of
assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1,2000:
� The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an
adoptive parent or a step-parent of the child is 0 percent[72 P.S.§9116(a)(1.2)).
• The tax rate imposed on the net value of transfers to or for the use of the decedenYs lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)�.
• The tax rate imposed on the net value of transfers to or for the use of the decedenYs siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is
defined,under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
REV-1502 EX+(02-15)
� pennsylvania SCHEDULE A
DEPARTMENTOFREVENUE REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
DOROTHYIPECKOVER
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which properiy
would be exchanged between a willing buyer and a wiliing seiler,neither being compelied to buy or sell,both having reasonable knowledge of the relevant facts.
Real property that is jofntly-owned with right of survivorship must be disclosed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
ITEM Include a copy of the deed showing decedenYs interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1. NONE 0.00
TOTAL(Also enter on Line 1, Recapitulation.) S 0.00
If more space is needed,use additional sheets of paper of the same size.
REV-1503 EX+(02-15)
� pennsylvania SCHEDULE B
DEPARTMENTOFREVENUE
INHERITANCETAXRETURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
DOROTHYIPECKOVER
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. NONE 0.00
TOTAL(Also enter on Line 2, Recapitulation) $ 0.00
If more space is needed,insert additional sheets of the same size
REV-1504EX+(9-12) SCHEDULE C
pennsylvania CLOSELY-HELD CORPORATION,
DEPARTMENTOFREVENUE PARTNERSHIP OR
INHERITANCE TAX RETURN
RESIDENT DECEDENT SOLE-PROPRIETORSHIP
ESTATE OF FILE NUMBER
DOROTHYIPECKOVER
Schedule C-1 or C-2(including all supporting information)must be attached for each closely-held corporation/partnership interest of the decedent,
other than a sole-proprietorship.See instructions for the supporting information to be submitted for sole-proprietorships.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. NONE 0.00
TOTAL Also enter on line 3, Reca itulation $ 0.00
(If more space is needed,insert additional sheets of the same size)
REV-1507 EX+(02-15)
SCHEDULE D
pennsylvania
DEPARTMENT OF REVENUE MORTGAGES & NOTES
INHERITANCE TAX RETURN RECEIVABLE
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
DOROTHYIPECKOVER
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. NONE 0.00
TOTAL(Also enter on Line 4, Recapitulation) $ 0.00
(If more space is needed,insert additional sheets of the same size.)
REV-1508EX+(p2-15) SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENTOFREVENUE PERSONAL PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
DOROTHYIPECKOVER
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. WELLS FARGO CASH ACCOUNT 1,223.86
TOTAL(Also enter on Line 5, Recapitulation) $ 1,223.86
If more space is needed,use additional sheets of paper of the same size.
REV-1509 EX+(02-15)
� � pennsyivania SCHEDULE F
DEPARTMENT OF REVENUE
JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
DOROTHYIPECKOVER
If an asset became jointly owned within one year of the decedenYs date of death,it must be reported on Schedule G.
SURVIVING JOINTTENANT(S)NAME(S) ADDRESS RELATIONSHIPTODECEDENT
A. CELIA PECKOVER 100 CLINES CHURCH RD ASPERS, PA 17304 DAUGHTER
B.
C.
JOINTLY OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANKACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENTS vALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER.ATfACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST
1. A. 4/4/02 PNC BANKACCOUNT8019774352 13,853.30 50.00%
6,926.65
2. A 6/1/81 BANK OF AMERICA 5783 5,606.79 50.00%
2,803.40
TOTAL(Also enter on Line 6, Recapitulation) $ g,730.05
If more space is needed,use additional sheets of paper of the same size.
REV-1510EX+(02-15) SCHEDULE G
pennsylvania lNTER-VIVOS TRANSFERS AND
DEPARTMENT OF REVENUE
INHERITANCETAXRETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
DOROTHYIPECKOVER
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
DESCRIPTION OF PROPERTY
ITEM INCLUDETHENAMEOFTHETRANSFEREE,THEIRREL4TIONSHIPTODECEDENTAND DATE OF DEATH %OF DECD�S EXCLUSION TAXABLE
N UMBER THE DATE OF TR4NSFER.ATTACH A COPY OF THE DEED FOR REP.L ESTATE. (iF navucae�e�
VALUE OF ASSET INTEREST VALUE
1. WELLS FARGO IRAACCOUNT 6189-5817 54,356.13 100.00% 3,500.00 50,856.13
TOTAL Also enter on Line 7, Reca itulation $ 50,856.13
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+(02-15)
� pennsylvania SCHEDULE H
DEPARTMENTOF REVENUE FUNERAL EXPENSES AND
INHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
DOROTHYIPECKOVER
DecedenYs debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. HOLLINGER FUNERAL HOME AND CREMATORY EXPENSES 7,786.00
2. CEMETARY MEMORIAL PLAQUE 2,800.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s) CELIA PECKOVER
StreetAddress 100 CLINES CHURCH RD
city ASPERS state PA z�P 17304
Year(s)Commission Paid:
2. Attorney Fees:
3. Family Exemption:(If decedent's address is not the same as claimanYs,attach explanation.)
Claimant
Street Address
C�� State ZIP
Relationship of Claimant to Decedent
q. Probate Fees: 125.50
5. Accountant Fees: 400.00
6. Tax Return Preparer Fees: 200.00
7.
8.
TOTAL(Also enter on Line 9, Recapitulation) $ 11 311.50
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+(02-15)
� pennsylvania SCHEDULE i
DEPARTMENT OF REVENUE DEBTS OF DECEDENT�
INHERITANCE TAX RETURN
RESIDENT DECEDENT MORTGAGE LIABILITIES &LIENS
ESTATE OF FILE NUMBER
DOROTHYIPECKOVER
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
VALUE AT DATE
ITEM
NUMBER DESCRIPTION OF DEATH
1.
OMNICARE INC HEALTH SUPPLIES 314.66
2. CUMBERLAND CROSSING NURSING HOME CARLISLE PA 6,045.00
3. HORIZON BCBS 943.92
4. CHASE EPAY-FOR HEALTH SUPPLIES 98.60
5. OMNICARE INC PERSCRIPTIONS 10.00
6. OMNICARE SUPPLIES 4•02
TOTAL(Also enter on Line 10, Recapitulation) $ 7,416.20
If more space is needed,insert additional sheets of the sarne size.
aev-isr3 Ex+ �oz-is)
� pennsylvania SCHEDULE ]
DEPARTMENTOF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
DOROTHYIPECKOVER
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and trensfers under
Sec.9116(a)(1.2).]
1. CELIA PECKOVER 100 CLINES CHURCH RD ASPER,PA 17304 -0AUGHTER 50%
2 KAREN PECKOVER 1605 RENAISSANCE COMMON BLVD#535 DAUGHTER 50%
BOYNTON BEACH,FL 33426
ENTER DOILAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
L
TOTAL OF PART II— ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed,use additional sheets of paper of the same size.
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PROOF FOR SCHEDULE E
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PROOF FOR SCHEDULE F
10/09/2014 21:29 7176778208 JEROME E LESNIAK LLC PAGE 02
� ��ap� 2�. 2014 1 ; 16PM PNC Bank No, 3396 P, 2
����
Septembc�23,�014
xud�Y'a�
�'NC�anlz
Mount Hally Office
RE: Dorothy 1'er.�over
SSN�: 150�26-1188 ,
AOD: 07/22/2p 1�L
UGar Sir/Madam:
In response to pour r�qu�st for 17at�of Ueatk(pqi})balances for the cusioz�ner nat�d abovc,our
rtcords shor�r the follor�►ring:
Checkin�Accoan#
Account# 8019774352 �stablished: 0�/04/2002
DOkAT�-T'Y�'�CT�O'V�R
CE�IA PECKQVER
A0�balan,ce: $ 13,853.15+Q,15 e�CCztted�n.terest
Please not�e rlyat this office pro�ides da�e of death ba]aneos for deposit accaunts(�R,A,s, CDs,Ck�ccking and
S�vin�s). We do not prqce��a�ny�i�p�tnCis�l trausarfions or prp�vide st�tements. Yf you nced�ssi�tax►ce witb,
� an�af'the�e it�ms,please call 1-888-T�N'C-�AN'K(1-8gg=762-22b5)ar stn�by your�ocal PNC B�nk�r�ch
p£�ice.
Slz7CeX�2��', .
National�iz�anci�l Servicas Cettttr
�NC Bank,N.A. '
1V.(emb�r�'DTC
�'l�f.S message is inte�ded for the u,se af ihe individucrl or enttty ta which it rs addressed and mczy
consatn informatton that is privileged, enrif�dential ar�d exempt fr�om d'isclosure under applicable law.
I'f the reader of this r►sessage ts riot the intertded r�cipient o�t�ie employee or agen�responsfbde for
delrverrng this r,aessage ta t�e int�ru�ed t�ecipienr,you�re h�r�by not{��d ihat any disseminatfor�,
distrdbution or copying of rhis communiC�ztfans is strictly prohibited. If you have received this
communiCatlon in error,please natify me immedtately by repIy or by telephone at 800-762-1775 and
imtnediately destroy this faoced document,
page 1 ot'1
5 �s o�... l�ss�cr`: c,,Y,�.
� N`�'` 1 `�'� �'�`�°°"�"�' �' `�' BankofAmerica�''�I
��,�.�.:��..,.�,�., a-r..� �ew�..
S� � � (..� G, •t•`r_.r rt_� j'��v'_ ; `.:.s /�,.,� i-�-4'Y"._s, �r� f� � , . '!:� �, ,+.:r 4
, � � AL�G. � [- '� �`� '`��F r.�/`
August 29, 2014
Celia Peckover
100 Clines Church Road
Aspers, PA 17304
Regarding the es�ate of: Dorothy Peckover
Dear Celia Peckover:
Thank you for contacting us regaxding the estate of Dorothy Peckover.
Listed below is the financial information you requested on the account(s) held in the name of the
above referenced decedent as of the date of death of 07/22/2014:
De osit Accounts: —
Account T e Number Account Details
Checking **********5783 Balance at date of death: $5,606.79
Accrued interest: $O.OU
Current balance: �577.19
Status: Open Opened 06/O1/81
Title: Dorothy Peckover
Celia Peckover
Please also be advised that no Safe Deposit Box was found.
Credit Accounts:
Account T e Number Account Details
Line of Credit **********6299 Current balance: $0.00
Status: Closed Opened 07/06/90 Closed
08/25/14
Name of borrower{s)/cardholder(s)
Dorothy Peckover
00-59-2728NSBW V0913
� BankofAmerica'`��I
Additional Information
Please call the applicable toll-free number(s) li"sted below for additional information:
Consumer accounts: 1.866.406.8426
If you need additional assistance, such as obtaining statement copies, copies of signature cards, or
closing checking or savings accounts, please mail your written request to our legal correspondence
center at the address below:
Bank of America
Enterprise Estate Unit
PO Box 982238
El Paso, TX 79998-2238
If you have any questions regarding this letter, please call us at 1.803.832.7770, Option 7, Monday
through Friday from 8 a.m. to 5 p.m. Eastern.
Sincerely,
Account Validation
BQIL
00-59-2728NSBW V0913
> s
PROOF FOR SCHEDULE G
� i � �.� �
08/05/2015 01:42 7176778208 JEROME E LESNIAK LLC PAGE 01
f —,� ,_�
We11�Far�o Advl+orti LLC
130 Herbour Alace Drive,Suite 200
Davidson,f1C 28036
7'e1:704�&55-0066
Toll Pree:877-B54-fl068
DOROTNY P�CKOVER 7�2Z�Z014 7/2Z/2014 7/��/2014
ACCOUNT# SYMBOL CUSIP# #SHAAES WIGH LOW MEAN VALUE
M�NEY
6745-6704 MARKET 1223.850 $1,223.85
'�OTAL S1,�Z3,85
�QROTWY PECKOVER IRA
�/z2/�oia �/zz/7o�a �/22/2vla
ACCOUNT# 5YMBOL CUSIP�i #SHAR�5 W��H LOW MEAN VAI.UE
6�$9-5617 COP 20825C-10-4 1�0.800 $6.11 84.86 $5.4$5 $8,54$.50
6189-5817 MRK 58933Y-10-S Z00.000 58.80 58.37 58.585 511.717.00
6189-5817 SBUX 855244-30»9 200,000 79.03 78.20 78.615 �15,723.00
6189-5$il JPM 46625H-10-0 �OO.aoa 58.80 58.37 58.585 $11,717.Q(y
CA5H 6650,130 $f,65A.G3
TQTAL $54,356.13
The abovo swnmary of prices has been obtained from saurces believed to be reliablc,but is not necessarily
con,plete and cannoc be ¢uarar�teed. Prices may not reflect the value at which securities could be sold.This
summary is for information purposes anay.Past results do nut indicate future per£ormanc�.This is not a
substitute far a Verification of Deposit(or similar form)or your Wells F�'go Advisors client si�tements and
trade cdnfirmations,which Well�Fargv Advisors considars the only offrcial and accurate records af your
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Celfe Peckover
100 Clines Chur�h�toad
�spers,QA 1�3oa
The funera�5ervice for porothy 1.Peckqver:
We sincerefy appreclate the tonfidenGe yeu have placed In us and wiil continu�to assist ydu In evety
Wpy we�81�. Please fe�l fre4 to oontact u�if you have any questlons In regard tQ thls statement.
TME FOLLOWIN�x 15AN ITEMiZEp STA1"�M�NTOf TME SERVICE5,FACILITI�5,AUTQMOTIVE�UUIPMENT,
AND MERChIANp15E THA7 YpU SELECTED WHEh!MAlCING TME FUNERAL ARRANGEMENI'S.
Prol'e�.+ional SaMce
Servtces of Funeral Direc�,r/StaFF $Z565.o0
5anit�ry/Cu�todl�l Gare �95.00
Transportat{on Wo�dbrldge,h�J 3���aA
Use dt�qulprnent for Graveside 395.00 .
Morth�ndiN
Cesket—Easton SM ��Da�dn
�irav@ Liner �8�•�
AT YH�TIME FUN�RAL ARItANGEMENI'S WERE MADE,WE AC/YANCEO CERTAIN PAYMENTS TO OTHERS
AS AN ACCOMMODA'�ION. TWE KOtLQWING!S AN ACCOUN'�lNG FQa TNOSE CMARC�ES.
Caxh Advonas
Gr�v�Qpaning/Clasing 2a00.00
Lot 8nd D�ed reservetiprt fee 1�,�
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08/05/2015 00:16 7176778208 JEROME E LESNIAK LLC PAGE 01
HAII'NM MEMORIAI. CENTER
10 MI�►IN S'TREET
WpQDBRIDGE, NJ 07C9�
ROBlR"T KATZ (BpB)
T32-634850Q 8HOWRCOM
7�2-�38-088Z DIRECT LfNC
itWK NUMENT Mpl .GOM
8-5-15
Celia,
�'his is a receipt that you requested showing the memorial is paid in fuli.
The total cost was$280�.00 .The memarial is paid and is set at the cemetery.
7hank you,
Bob Katz
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08/13/2014 03:46 7176778208 JEROME E LESNIAK LLC PAGE 02
RECETPT �'OR PAYMENT
LISA M. GRAYSON, ESQ. Rec�ipt Date: 8/13/2014
Cumberl�nd County - Register Of Wills Receipt Time : ti2 :36 :22
One Co�rthouse S auare Rece�pt No, : 1078878
Carlisle, PA 17613
P�CKOVER DOROTHY I
Estate �'ile No. : 2014�00757
Paid By Rema�ks : CELIA �ECKOVEIt
pB�
--------------------�T--- R�ceipt Distribution -�------�------�---------
Fee/'rax Description Paym�nt Amoun� Payee Name
P�TITZ�N LTRS '�EST 20 . OD CUMBERL,AI�L� COUNTY G�NERAL FUN
WII,L 15 . 00 CUMBEI2LAND COUNTY GENERAL FUN
�7'C5 FEE 3 5 . 5 0 BUF�EAU QF REC�I PTS & CNTR M.D
SHORT CERTIFZCA'�� 20 . 00 CUMBERLAND CQUNTY GENERA� FUN
AUTOMATTON FEE 5 . 00 CUMRERLAND COUNTY GENERAL FUN
YNVENTORY 15 . 00 CUMBERLAriD COUNTY GEN�RAL FUN
INH TAX R�'TURN 15 . 00 CUMBERLA�TD COUNTX GENERAL FUN
Check# z96 , � T $125 . 50
Total Rece�ved. . . . . . . . . $�25 . 50
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SUSAN C MOSSER, PC
357 YORK ST
GETTYSBURG, PA 17325
717-337-0162
Invoice for 2014 Tax Year
DOROTHYIPECKOVER
100 CLINES CHURCH RD
ASPER, PA 17304
Invoice Date:August 05, 2015
Statement of Charges
PA INHERITANCE Tax return preparation fee 400.00
TOTA L 400.00
� �.. ,.�. �. � �
SUSAN C MOSSER, PC
357 YORK ST
GETTYSBURG, PA 17325
(717) 337-0162
' Invoice for 2013 Tax Year
DOROTHY PECKOVER
100 CLINES CHURCH ROAD
ASPER, PA 17304
Invoice Date: September 25,2014
Statement of Charges -
Tax return preparation fee 100.00
TOTAL 100.00
illllll 1 I�.IIIII 1
SUSAN C MOSSER, PC
357 YORK ST
GETTYSBURG, PA 17325
717-337-0162
Invoice for 2014 Tax Year
DOROTHY PECKOVER
100 CLINES CHURCH ROAD
ASPER, PA 17304
Invoice Date:August 05, 2015
Statement of Charges
Tax return preparation fee 100.00
TOTAL 100.00
, , , . . .
PROOF FOR S CHEDULE I
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Interest Checking X)OOOIX4352 Availabie Balance: 517,485.97
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Pending Transactions
These transactions haw been submitted to us since the lastbusiness dayand are notyet posted to your
account.When they have posted,theywill be reflected in your Posted Transactions.Pending Items mayaffect
your Available Balance and are not a statement of your account
Date Descr/ptlon Wlthdrawals Deposits
This account has no Pending Tiansac6ons
Posted Transactions
Date Descrlptlon Wlthdrawals Deposil• Balan�
08/01Y1014 CHECK295084479629 $17,485.97
OSI01/2014• ACH DEBIT)0000C1188 HORIZON BCBS NJ PREM. $943.92 $25• •9�
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